NEUROGENIC STUTTERING
What is neurogenic stuttering? Neurogenic stuttering is a type
of fluency disorder in which a person has difficulty in producing speech in
a smooth fashion. Individuals with fluency disorders may have speech that
sounds fragmented or halting, with frequent interruptions and difficulty
producing words without struggle. Neurogenic stuttering typically appears
following some sort of injury or disease to the central nervous system i.e.,
the brain and spinal cord, including cortex, subcortex, cerebellar, and even
the neural pathway regions. In the majority of cases, the injury or disease
that caused the stuttering can be identified. In a small number of cases,
however, the individual may only show evidence of some form of speech
disruption without any clear evidence of neurological damage.
Who is at risk for neurogenic stuttering? Generally
individuals experiencing neurogenic stuttering have had a history
of normal speech production prior to the injury or disease. In a few
cases, neurogenic stuttering may occur in individuals who experienced
developmental stuttering in childhood but had apparently recovered.
Neurogenic stuttering can occur at any age; however, it appears more
often in adulthood, and the highest incidence is in the geriatric population.
This profile is quite different from developmental stuttering which is not
typically seen as a result of brain damage and which most commonly
appears in early childhood in children between 2 and 5 years of age.
What are the primary symptoms of neurogenic
stuttering? Because it results from a very diverse set of diseases and
disorders, the symptoms of neurogenic stuttering may vary widely between
different individuals. Neurogenic stuttering might be considered as a
possible diagnosis if one or more of the following symptoms are observed:
• Excessive levels of normal disfluencies or interruptions in the forward
flow of speech, such as interjections and revisions
• Other disfluencies, such as repetitions of phrases, words, and parts of
words (sounds or syllables, prolongations of sounds)
• Hesitations and pauses in unexpected or inappropriate locations in an
utterance
• Cessation of speech during the production of a word without finishing
the word
• Intrusive or extraneous additional sounds during speech production
• Rapid bursts of speech which may be unintelligible
• Extraneous movements of lips, jaw, or tongue while attempting
to speak, including posturing.
Many individuals may appear to be unaware of or unconcerned about the
disruptions in their speech. Others may show awareness, and possibly
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express anxiety and even depression about their difficulties
in speaking. This may be accompanied by other behaviors,
which may include:
• Secondary or associated behaviors, such as obvious
tension and struggle in speech production; movements
of head or limbs while speaking; reduced eye contact;
• Postponement in attempting to say a word or
avoidance of words or speaking situations.
These behaviors may arise from the speaker’s attempts to
overcome or force his way through the disfluency, or from
attempts to hide that he is having difficulty producing
normal sounding speech.
How does neurogenic stuttering differ
from other types of fluency disorders? The
symptoms of neurogenic stuttering can be similar to those
seen in other fluency disorders. Some communication
disorders such as dysarthria, apraxia of speech, palilalia,
and aphasia may impair the speaker’s ability to produce
smooth and flowing speech production. These problems
result from the same types of neurological injury or disease
as neurogenic stuttering, and the disorders often co-exist.
A diagnosis of neurogenic stuttering might be considered
when the disfluency pattern includes the symptoms
described above.
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Occasionally, some individuals may experience psychogenic
disfluency. This disorder results in a disfluent speaking
pattern but no medical factors or history of developmental
stuttering are present. Its appearance may be linked
to emotional stress or trauma that the individual has
recently experienced. The disorder whose symptoms most
resemble those of neurogenic stuttering is developmental
stuttering. Developmental stuttering may persist into
adulthood. In some cases, its symptoms may be noticeably
worsened following injury, disease, or trauma, possibly
making diagnosis between the two disorders more
difficult. Similarly, an individual who had recovered from
developmental stuttering in childhood may experience a
re-emergence of stuttering following neurological injury
or disease. In the vast majority of cases, however, the
sudden appearance of disfluent speech in an adult should
be considered abnormal. Developmental stuttering should
only be considered as a possible cause when there is a prior
history of childhood stuttering. Apart from the obvious
difference in age of onset, differentiating between the two
disorders is often difficult.
 Some of the patterns that set the two apart include:
• Neurogenic stuttering may occur at any point in the production of
a word, rather than primarily at the beginning, as is common with
developmental stuttering.
• Neurogenic stuttering often occurs on any type or class of word
anywhere in a sentence rather than being linked to content words
such as nouns, verbs, adjectives and adverbs.
• Neurogenic stuttering may occur in any type of vocal behavior,
including singing and repeating memorized passages, such as the
pledge of allegiance. Disfluencies may occur with equal frequency in
any type of a speaking situation.
• Neurogenic stuttering is often not alleviated by the same
conditions that significantly lessen developmental stuttering. These
include choral reading, singing, adaptation (repeated oral reading
of the same passage) or speaking while under auditory masking or
delayed auditory feedback.
The aforementioned patterns, however, are not universal for all
individuals experiencing neurogenic stuttering, and patterns may vary
widely across individuals depending on the nature of the neurologic
injury or disease.
Can other types of communication problems
accompany neurogenic stuttering? It is not uncommon
for individuals with neurogenic stuttering to experience several other
types of communication impairments. These might include:
• Aphasia—complete or partial impairment in language
comprehension, formulation, and use
• Dysarthria—errors in the production of the speech sounds,
such as slurring of sounds and words that affect the intelligibility
of the individua’s speech
• Apraxia of speech—irregularities in the timing and inaccuracies
in the movement of the muscles used in speech production
• Palilalia—speech disorder in which a word, phrase, or sentence
may be repeated several times, generally with increasing rapidity
and decreasing distinctness
• Anomia—difficulty in finding the appropriate word to use
• Confusion—uncertainty as to their own identity and that of
others, their location, current time period, etc.
How is neurogenic stuttering diagnosed? Before getting
treatment, it is important that someone suspected of neurogenic
stuttering be diagnosed accurately. It is advisable to consult with a
speech-language pathologist who specializes in stuttering to make the
diagnosis. The SLP will want to seek input from the physicians involved in
the clients’ care. The evaluation will include consideration of the fluency
problem and the individual’s case history, current medical status, and
the presence of other communication impairments. The diagnosis should
determine whether the disfluency is neurogenic in origin and whether
any other communication impairments are affecting fluency.
P.O. Box 11749 Memphis, TN 38111-0749 ˙ stutteringhelp.org ˙ tartamudez.org ˙ info@StutteringHelp.org ˙ 800-992-9392
How is neurogenic stuttering treated? Because
many conditions can cause neurogenic stuttering and affect the
frequency with which it co-exists with other communication
impairments, there is no single treatment approach that is
effective in alleviating its symptoms. Treatment is often carried
out by a speech-language pathologist working in conjunction
with the clients’ physicians. Some therapy techniques that help
reduce the symptoms of developmental stuttering may also be
effective with neurogenic stuttering. These include:
• Slowing speech rate (saying fewer words on each breath
by increasing the duration of the sounds and words).
• Emphasizing a gentle onset of the start of each phrase
(starting from a relaxed posture of the speech muscles,
beginning with adequate respiratory support, a slow and
easy initiation of the exhalation and gentle onset of the
first sound).
• Emphasizing a smooth flow of speech production and
use of relaxed posture, both in terms of general body
posture and for specific speech production muscles.
• Identifying the disruptions in the speech patterns and
instructing the client in the use of more appropriate
patterns.
In addition, if the person is expressing anxiety or concern about
his fluency, therapy may include education about the disorder
and counseling to change attitudes and perceptions. The use
of different or additional techniques and approaches may be
indicated based on the presence of other communication and
cognitive disorders and the nature of the individual’s underlying
neurological condition. If other communication disorders are
also present, additional therapy directed at alleviating their
effects may enhance fluency as well. Physicians, nurses,
occupational, physical, and respiratory therapists may also be
able to provide assistance in dealing with medical conditions
and symptoms which have an impact on speech fluency.
Having an understanding of the disorder can help families
and caregivers structure communication situations to best
help the client. This can have a significant impact on reducing
their concerns and improving communication. Strategies
may include simplifying one’s speech, allowing more time
for response, modeling slow, easy speaking patterns, and, in
general, reducing communication demands and expectations.
It is important to recognize that the recovery process from
the underlying neurological injury or disease will often have a
significant impact on fluency. Also keep in mind that because
recovery from neurological injury or disease may be slow,
patience will be needed.
How can I get help for neurogenic stuttering?
The Stuttering Foundation of America can supply you
with the names of speech-language pathologists who
specialize in stuttering. Call toll-free 800-992-9392
or visit www.StutteringHelp.org.